Ghana & USA: Service Quality

Shared medical appointments are not only more efficient from a facility flow perspective but can also help patients develop supportive communities. This is particularly true for antenatal (ANC) and postnatal care, where women attend group visits with women of a similar gestational age, sharing information and forming relationships within and outside of the facilitated group visit. Compared to individual visits, women are able to spend more time with providers, form relationships with providers and other mothers, and reinforce knowledge with one another.1 A group ANC curriculum was implemented in Ghana using seven lesson modules designed by the American College of Nurse-Midwives. Each of the sessions was 60 minutes and involved story-telling, peer support, and demonstration with a focus on delivering information to women with limited literacy. This design was compared to individual ANC with the same providers, and women who received group ANC care were more likely to discuss delivery arrangements and transportation with midwives, have saved money for birth, report positive exclusive breastfeeding practices, and discuss newborn problems with midwives. Thus, group visits for ANC can contribute to facility efficiency while better equipping women with maternal knowledge.1

Shared medical appointments have been used extensively for NCD management in high-income countries to limit repetition of educational medical appointments and build cohorts of patients with similar needs and concerns.2 A study of shared medical appointments for diabetes in The United States found that the success of these programs depended on patients’ motivation and willingness to learn and could contribute to improved patient satisfaction and productivity.2 While there is limited evidence of shared medical appointments for NCDs in LMICs, the success of shared appointments for ANC suggests that shared medical appointments may continue to be a strategy for improving clinic efficiency.


  1. Lori JR, Ofosu-Darkwah H, Boyd CJ, Banerjee T, Adanu RMK. Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy Childbirth [Internet]. 2017;17(1):228. Available from:
  2. Sanchez I. Implementation of a Diabetes Self-management Education Program in Primary Care for Adults Using Shared Medical Appointments. Diabetes Educ [Internet]. 2011;37(3):381–91. Available from: